DESCRIPTION: (Applicant's Description) Problems with the quality of terminal care and with how medical education addresses the end of life have been widely recognized in both public and professional forums. Yet only a handful of palliative care fellowships currently exist in the United States to train the academic physicians who can practice and teach excellent end-of-life care and provide leadership in this emerging field. We propose to establish an exemplary fellowship that allows physicians to develop the expertise for carrying out and teaching "best practices" in end-of-life care, and also sets a standard for palliative care training. We will first develop a model one-year fellowship for clinician-educators. In year two of the grant, we will begin selecting fellowship candidates for a two-year clinician- investigator track that includes training in research. Funding is sought to support the fellowship, strengthen the clinical training, and develop the added research component. Based primarily in the well-established, busy, growing Palliative Care Service at the Massachusetts General Hospital but also drawing on many institutions affiliated with Harvard Medical School and a variety of hospice, home care, and subacute care programs in the Boston area, we are ideally suited for offering exposure to diverse clinical materials and research. The core faculty is the staff and consultants of the Palliative Care Service, who will provide expert team supervision in a broad range of settings. Building on a number of previous courses, including faculty development programs, we have structured a model program that assures ample exposure to and rigorous supervision in interdisciplinary team management of an array of complex patient and family problems in terminal care. Drawing also on diverse educational programs, we provide the fellow with opportunities for many kinds of teaching. Our program to train the fellow for the teaching role focuses on small group, case-based, learner-centered education, teaching on rounds, addressing learners' fundamental attitudes toward terminal care, enhancing basic communication skills, and leadership in institutional change. Personally tailored learning opportunities are also offered. Regular, multidimensional feedback sessions will be used to guide the fellow and faculty. The impact of the training on the fellow will be measured through a series of evaluation exercises. Plans for dissemination of curricular materials and for a description of the fellowship are outlined. Diverse research training programs will be offered for the second and later years. Emphasizing the comprehensive, interdisciplinary nature of palliative care, coordinated across multiple care sites, we seek to establish a standard for excellence in training in this field, and to develop leaders in clinical work, health care education, and research.